Provider First Line Business Practice Location Address:
1124 W RIVERSIDE AVE
Provider Second Line Business Practice Location Address:
SUITE LL2
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-1132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-981-9851
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2007